LRTI Flashcards
What are the 3 main types of LRTI
- COPD exacerbation- need to be 2/3 symptoms - increased SOB, increased sputum volume or increased sputum purulence
- Non-pneumonic LRTI
- Community acquired pneumonia
How is community acquired pneumonia assessed in primary care
- Symptoms of LRTI (cough + 1)
- Atleast 1 systemic feature - temp >38/ flu symptoms
- New focal chest signs on auscultation
- No other explanation for illness
How is community acquired pneumonia assessed in hospital
- Symptoms and signs of acute LRTI
- New X–ray shadowing with no other explanation
- Illness primary reason for admission
What are the main causative organisms in CAP
- Strep pneumoniae
- Chlamydia pneumoniae
- Chlamydia psitaci
- Mycoplasma pneumoniae
- TB in elderly, indian, history of TB exposure
- Fit/ young= more likely to be LRTI - clinical diagnosis
- Older/ co-mobidities- have more caution for pneumonia
How do you differentiate between CAP and acute bronchitis
-Acute bronchitis will have normal vital signs and no focal consolidation on chest exam
- Pneumonia will have any of these signs
- Temp > 35 or >40 -Pulse >125/ min -Resp rate>30 -Low BP -Confusion -Age > 50 -Co-morbidity
What is the CRB-65 score
- Used in primary care
- 1 point for each factor
- Confusion -Resp rate> 30 -BP - SBP<90 or DBP<60
- Age>65
- Score of 1 or 2 consider hosp
- Score over 3- urgent hosp
What is the CURB-65 score
- Conducted in hospital
- 1 point for each
- Confusion -Urea>7mmol/L -Resp rate>30 -BP- SBP >90 DBP >60 -Age>65
- Intensive care if score is very high
What investigations are conducted for CAP
- Sputum- stain (quick) and culture (abs sensitivities)
- Blood cultures
- FBC for WCC and Plt and CRP
- Urinary antigen- Legionella pneumonia seogroup 1/ pneumococcal antigens
- Serology- atypical and legionella
Give initial antibiotics within 4 hrs don’t wait on results
What are the treatment steps for non-severe CAP
-Home or social hospital admission
-Oral amoxicillin TDS/ ampicillin QDS - 0.5- 1g and frequently
OR
-Erythromycin 500mg QID
-Clarithromycin 500mg BD
What are the treatment options for non- severe CAP in a hospital setting
-Combination treatment to cover typical pathogens- pneumococci and haemophilia + atypical pathogens - chlamydia and mycoplasma
Oral- Amoxicillin and macrolide (erythromycin or clarithromycin) - if allergic give levofloxacin or other resp quinolone
IV if vomiting or oral not working- Penicillin + macrolide
GIVE CLARITHROMYCIN IV AS ERYTHRO IS TOXIC TO VEINS
2nd line= levofloxacin
What are the treatment options for severe CAP treatment
-Hospital/ ICU
-IV beta lactam and macrolide
-Co-amoxiclav/ cephalosporin (cefotaxime)
+macrolide
+ rifampicin (if legionella)
Describe the features of Tuberculosis
- Can affect any body system not just lungs
- Mycobacterium is causative organism- prolonged close contact with open respiratory TB
- 70% people won’t get infected
- Of the 30% that get infected 90% will have asymptomatic latent TB and 10% will have acute illness
- Chronic pneumonia is the most common form of TB- always consider as a differential for CAP
- Night sweats and weight loss- good indicators of TB
- CXR will show upper lobe disease- upper lobe consolidation, cavitation, hilariously lymphadenopathy and calcified lymph nodes
What are the risk factors for TB
- Personal / fam contact with TB
- Live/ work in endemic TB areas- Africa, India, Portugal, Estonia, prisons, social care
- Immunosuppression
How is TB diagnosed in the lab
- Microscopy - quick and simple, poor sensitivity
- Culture- Gold standard- gives diagnosis, susceptibilities, sensitivities- important in drug resistance, very slow to culture need special incubators
- Amplification tests- fast, specific, sensitive but expensive
- Gamma interferon tests- Blood test version of skin test- only needs 1 patient visit, very replicable but expensive and only good at picking up latent TB
How is TB treated
- FULL ADHERENCE NEEDED
- 6 months isoniazid and rifampicin
- For first 2 months also give pyrazinamide and ethambutol
